Impact of a Community Respiratory Assessment Service on evidence based prescribing in primary care

Patel, I.S.; Milestone, H.; Dawson, S.; Killeen, L.; Bertenshaw, K.; Haffenden, R.; Roberts, Nicola Jane; Partridge, M.R.

Abstract

Introduction: The Community Respiratory Assessment Unit (CRAU) in Hammersmith and Fulham provides open-access nurse-led spirometry and evidence-based disease management support to primary care.

Methods: The primary care records of 100 patients referred from March 2008 to April 2009 (51M/49F, mean age 61 years, 77 current/ex-smokers) were examined to quantify whether suggestions made in the CRAU had been translated into practice.

Results: In 32 patients no treatment change was recommended as they were already on optimal management (18 mild COPD, 8 moderate COPD, 1 severe COPD and 5 with asthma). No therapeutic changes were recommended in a further 10 with a restrictive defect and in 21 with normal spirometry. Of the 37 patients in whom a change in treatment was suggested, 29 (78%) had COPD (16M/13F, mean age 71 years, 21 current smokers, 17 mild, 8 moderate, 4 severe disease), 7 had asthma (4M/3F, mean age 39.7 years, 3 current smokers) and 1 had normal spirometry. The referring GP adopted suggested changes fully in 18 patients (49%) and partially in 5 (13%). In 14 patients (38%) the recommended alterations were not made. The range of suggested alterations of pharmacotherapy and rates of implementation in primary care are shown in table 1. In 6/18 (30%) cases where inhaled corticosteroids (ICS) or a combination of a long-acting β agonist with ICS were recommended, this was not adopted. In 8/14 (57%) cases where tiotropium was recommended, this was not adopted.

Conclusion: Over 50% of patients with COPD reviewed in a community assessment unit were not receiving optimal evidence-based pharmacotherapy. This could be explained by the fact that primary care physicians were awaiting the results of spirometry and assessment. However, following assessment, recommended changes to medication did not occur in a significant proportion of patients.

• Presentation Conference Type: Conference Abstract
• Conference Name: British Thoracic Society winter meeting
• Online Publication Date: Dec 1, 2009
• Publication Date: 2009-12
• Deposit Date: Aug 3, 2023
• Print ISSN: 0040-6376
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 64
• Issue: Suppl 4
• Pages: P46
• Series ISSN: 1468-3296
• Publisher URL: https://thorax.bmj.com/content/64/Suppl_4/A90